What can/should I do for hyperpigmentation after PicoSure? (Photos)

Question

July 2018 went to a doctor who used the tattoo setting on some scarring I had on my back. Told me it would blister then scab n fall off, with some slight HYPOpigmentation, it did exactly that but its darker than before I started. I went for the 2nd laser treatment with a more gentle setting but no real difference afterwards. I’m also doing glycoic peels 2x a month, with Kojic acid a few x a week. I’m at my wits end and feel hopeless. Should I contact the doctor for a refund? What can I do?

Jason Emer, MD · Answer

Hyperpigmentation can be improved with a combination of lasers, Aerolase, microneedling/prp, skin lightening, peels, Cosmelan and skin care. Sun protection is essential. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Monika Soni, MD · Answer

Hyperpigmentation can be improved with a combination of lasers, Aerolase, microneedling/prp, skin lightening, peels, Cosmelan and skin care. Sun protection is essential. I recommend getting a formal evaluation with a cosmetic dermatologist.

James Okamoto, MD · Answer

It is normal for the skin to be darker immediately after Picosure, and depending on the setting it can take a couple weeks for the skin to heal and begin regenerating - THEN when the skin has recovered it will be lighter in color than prior to treatment.  I am concerned that your skin has not had an opportunity to heal with the added glycolic peels and Kojic acid treatment.  Use a good sunblock (EltaMD has excellent products) even on cloudy days. If after 6 wks WITHOuT peels/acid you haven’t seen an improvement follow up with your dermatologist and see why it is not responding. When used at the proper settings, PicoSure is safe for ALL skin types without the risk of hyperpigmentation.

David E. Berman, MD (retired) · Answer

i am not sure what you were using or doing prior to starting your Picosure laser treatment. we recommend that you be off any active agents for 3 days prior to a treatment. also you cannot be tanned in the area being treated. For all of my patients with any color to their skin ie if they are ethnic at all, I recommend that they pre-treat (ie prior to getting a picosure laser treatment) for 2-3 weeks with 4-8% hydroquinone cream since this decreases the risk of hyper-pigmentation.I do not agree with Dr Emer below. i would suggest other than using Lytera or HQ  and a good sunblock, that you wait until the hyper-pigmentation resolves before you doing any types of treatments such as microneedling or slat facials etc etc. These will only further irritate the skin at this time and I believe are more likely to intensive the problem. it may take 6-12 months for this hyper-pigmentation to resolve. it is imperative that you use an excellent sunblock over this area. you will need to be patient.david berman md

What can/should I do for hyperpigmentation after PicoSure? (Photos)

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